Healthcare Provider Details

I. General information

NPI: 1447255468
Provider Name (Legal Business Name): WHITNEY MANOR OPERATING COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 10/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2798 WHITNEY AVENUE
HAMDEN CT
06518
US

IV. Provider business mailing address

2798 WHITNEY AVENUE
HAMDEN CT
06518
US

V. Phone/Fax

Practice location:
  • Phone: 203-288-6230
  • Fax: 203-230-2501
Mailing address:
  • Phone: 203-288-6230
  • Fax: 203-230-2501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2411
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: GIORGIO MAYER
Title or Position: OWNER
Credential:
Phone: 929-271-2556